How many times have you heard someone mention or talk about having diabetes, heart disease, depression or bipolar disorder? If you’re like most Americans, the first two are relatively easy conversations while the latter are rarely mentioned. Why? You have today’s stigma on mental health to blame.

The truth is, 2015 statistics show that one in five American adults experience a mental illness. Yet, because mental health is rarely talked about, these people often struggle in silence, according to the National Alliance on Mental Illness.

If millions of people are suffering each year, why has it become so hard to talk mental health? What can we do to decrease the stigma of mental health? And how could President Trump impact mental health care? ENTITY recently chatted with Dr. Lloyd Sederer, Chief Medical Officer of the New York State Office of Mental Health and author of “Improving Mental Health: Four Secrets in Plain Sight,” and Julie A. Fast, mental health advocate and author of books like “Loving Someone with Bipolar Disorder,” to see what barriers are keeping mental health out of public conversation and what changes you could expect in the future.

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1 Mental health is (wrongly) seen as separate from physical health.

When you break your leg, it’s hard to deny – or have others deny – that the pain exists. Physical pain is usually evident, with certain symptoms that quickly lead to a diagnosis—maybe a little less easily if you end up in front of Dr. House, but hey at least you’ll know you don’t have lupus.

With mental health, however, issues are often blamed on social factors – such as abuse or bad parenting – instead of being treated like the genetic diseases that they are. In fact, some experts like Mike Bundrant have even argued that the mental illness epidemic is a result of pharmaceutical companies’ wanting to sell more pills, and therefore encouraging more diagnoses and even creating conditions. Others even believe that mental diseases don’t exist at all because many can’t be medically proven by tests, and behaviors – like feeling depressed or anxious – aren’t necessarily diseases.

For Julie A. Fast, this distinction of “mental illness” from “real diseases” is just one of the many challenges she, and others with mental illnesses, regularly face. “I was born with bipolar disorder. It is in my family tree. I need a management plan and medications, just like someone with diabetes,” she says. “The idea that these are made up terms by drug companies or people who simply want to label human behavior in a negative way is the next challenge we can overcome. Once we face this and treat mental health as a physical illness, we will move to the next phase [of mental health awareness].”

Depression, schizophrenia or anxiety might be more complicated than a broken bone…however, people with them are just as worthy of receiving respect, acknowledgement and treatment for their medical issues.

2 Mental health problems are often linked to “weakness” or “danger.”

When you hear the phrase, “mental illness,” what images come to mind? A homeless man yelling nonsense on the street corner? Someone who just isn’t trying hard enough to be happy? What about a mass shooter?

If you regularly watch or read the news, you’ve probably noticed that violence is often tied to mental illness. For example, when talking about methods to reduce gun violence last January, President Obama commented, “We’re going to do more to help those suffering from mental illness get the help that they need.” And, when surveyed, 63 percent of American survey participants blamed America’s “deficient health care system” for recent gun violence. However, studies show that less than 5 percent of gun homicides from 2001 to 2010 were committed by people with mental illnesses, and researchers estimate that treating mental illness would only reduce violence by 4 percent.

As Dr. Sederer explains, mental illnesses are also often considered to be “some shameful condition or some sign of weakness,” and the public usually only sees negative images of people with mental illness since those who get better “don’t tend to talk about it.” Because of these misunderstandings, seeking health care for mental illness is heavily stigmatized…which results in 56.5 percent of adults with mental illness receiving no treatment (as of 2014).

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People with mental health issues aren’t crazy or to blame for society’s most violent crimes…and until those assumptions change, conversations can’t open up.

3 People aren’t mental health experts – or even novices.

If someone is having an allergic reaction, you probably know to call 9-1-1, take them to an emergency room or look for their EpiPen. But, when men and women are struggling with mental health issues, Dr. Sederer says people often “don’t know where to turn, or who to trust.” Even worse, he says, “Many times, people don’t have reliable or trustworthy information, so they’re sort of thwarted. They’re in trouble or a loved one is in trouble. You put those [lack of information on people and services] together, and they become very big challenges.”

People’s overall lack of knowledge about mental illnesses can have other negative effects, too. For instance, in a 2010 study, Dr. Moses examined the behavior of family, friends, peers and school staff to young adults with mental illnesses. Out of the 56 surveyed teenagers, 62 percent reported losing friends because of their mental illness (with the other 28 percent reporting that they conceal their mental illness from friends or only socialize with people struggling with similar issues), and almost half of the teenagers admitted being stigmatized by their family as well.

According to Julia Fast, people have a better understanding of mental illnesses than when she was diagnosed with bipolar disorder in 1995 and only “about one percent of the people I talked to understood the words ‘mental illness.'” However, it’s obvious that the U.S. still has a ways to go.

The biggest problem with mental illness today? For Julia Fast, it’s the “terrifically poor quality of mental health care we now have in the United States.” In fact, people with mental health problems experience barriers to medical care – ranging from costs to not having a primary physician – 2.5 to 7 times more often than people without mental illnesses. In 2014, one out of five adults with a mental illness reported that they couldn’t get the treatment they needed.

Even when people are lucky enough to have access to a doctor, they can struggle to receive the correct diagnosis and treatment. As Dr. Sederer points out, although mental health issues like depression are “more common than the general chronic conditions we often think about, like heart disease, they are profoundly under-treated.” In Sederer’s mind, the only way to fix the gap between need and care is to make checking for mental health conditions a standard part of primary care. “In the same way that you can’t go to your primary care doctor without having your blood pressure taken or your labs done, these [asking about or using questionnaires to check for depression, anxiety, etc] will become standard screening measures.”

The success rate for treating mental illness is high, with 80 percent of people being treated for clinical depression seeing improvement. But, to get better, people must ask for and receive good care in the first place!

5 President Trump could cut funding to important mental health legislation…but there’s still hope.

So what does all of this mean for the future of mental illness? Well, first off, it may get worse before it gets better. According to Dr. Sederer, there are rumors that President Trump will cut the Affordable Care Act (which requires insurance companies to cover mental illness services) and change the funding for Medicaid (the insurance used by poor and some disabled people). People are more likely to use mental health services if they’re insured, so if the Affordable Care Act goes away, Trump could “undue enormous gains” for mental health advocates.

Not only that, but people are also discussing using block grants for Medicaid. Right now, the federal government must match the money a state spends on Medicaid services. Using block grants would “essentially freeze the budget so that anything the state spends beyond [the given budget] is 100% on the state’s back.” In Dr. Sederer’s state of New York, Medicaid changing to block grants would “result in an immediate $5 billion reduction in the first year’s budget” – which means a big cut in services for the people who need them.

However, there is some hope. As Julie Fast explains, “Talking openly about mental health is a challenge we are meeting. People like Catherine Zeta Jones and the beloved Carrie Fisher talked openly and candidly about their bipolar. Kanye West’s PR team openly said he was having a psychotic break. Zayn Malik from One Direction talks openly about his panic attacks and even explains that he had to cancel a concert due to anxiety. The word depression is no longer a dirty word.”

The Bottom Line

The truth is, we still have a ways to go to talk about mental health problems openly and without judgement. We need to change the societal associations of violence with the mentally ill, and perhaps become even better supporters of loved ones struggling with depression or bipolar disorder. However, we’ve also come a long way – and we can still make progress, regardless of Trump’s policies or past barriers.

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